USPSTF Recommends Hepatitis C Virus Infection Screening for All Adults

In response to a spike in hepatitis C virus (HCV) infection cases among young adults, the U.S. Preventive Services Task Force (USPSTF) revised its guidance and is now recommending that all adults, not just older ones get HCV screening.

HCV Testing Trends

The last time the USPSTF issued HCV screening guidance was back in 2013 when adults born between 1945 and 1965 accounted for an estimated three-fourths of HCV infections. Accordingly, the guidance recommended screening only for adults in that high-risk group. However, the incidence of HCV infection has grown roughly 3.8-fold between 2010 and 2017. Growth in the infection rate has particularly affected younger people, especially intravenous drug users in the age range of 20 to 39. Other the that have been hit hard include American Indian/Alaskan Native and non-Hispanic white populations, according to the USPSTF.

The other significant development that prompted the organization to revisit its 2013 guidance is the availability of highly effective direct-acting antiviral (DAA) treatments that produce higher rates of sustained virologic response with fewer serious side effects than previous interferon-containing therapies.

The USPSTF Evidence Review

In response to these post-2013 developments, the USPSTF commissioned a systematic evidence review to address, among other issues:

• Whether HCV screening of adolescent and adults without abnormal liver enzyme levels reduces disease-related mortality;
• The effectiveness of different risk- or prevalence-based methods for screening on clinical outcomes;
• The yield of one-time versus alternative screening strategies for HCV infection;
• The potential harms of screening and antiviral treatments;
• The effects of interventions during childbirth;
• The effectiveness of currently recommended antiviral treatments in improving patient outcomes and achieving a sustained virologic response; and
• The association between a sustained virologic response following antiviral treatment and a reduction in the risk of HCV-related adverse health outcomes.

In addition to being wider ranging than the evidence review preceding the 2013 HCV screening guidance, the latest review also included adolescents.

The review found that all-oral DAA regimens were associated with sustained virologic response rates greater than 95 percent with few short-term harms compared with older therapies, and that such a response was associated with improved clinical outcomes compared with no response.

The review also found that screening remains highly accurate and that there were no observable differences in yield between repeat versus one-time screening or alternative screening strategies such as ones based on risk.

Also critical to the review were modeling studies indicating that expanded screening strategies would be beneficial, including one hypothetical cohort showing that screening all people in the U.S. ages 18 and older would identify approximately 256,000 additional HCV cases and result in an estimated 280,000 additional individuals achieving sustained virologic responses.

The New USPSTF Screening Guidance

The revised guidance, which were published in the March 16 issue of the Journal of the American Medical Association, broaden previous guidelines by recommending one-time screening in asymptomatic individuals ages 18 to 79, along with periodic screening for individuals at continued risk for HCV infection. More precisely, the USPSTF issued a B grade recommendation for HCV screening for all individuals 18 years and older. The grading indicates a high certainty of a moderate net benefit or a moderate certainty that the net benefit is moderate to substantial.

Takeaway

Keep in mind that the USPSTF guidelines and specifically the B grade for broader HCV screening, carry significant weight with not only providers but also payors. One big reason for that the Affordable Care Act requires private insurers and Medicaid to cover preventive services with no cost sharing if they are recommended by the USPSTF with a grade of A or B.